MEDICARE: DR. MARIA YIASSEMIDES, P.A.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor	S01553	MD

General Provider Information

NPI Number	:	1821369935
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DR. MARIA YIASSEMIDES, P.A.

Provider Business Mailing Address
First Line	:	3421 SWEET AIR RD
Second Line	:	SUITE 5
City	:	PHOENIX
State	:	MD
Zip	:	21131-1812
Country	:	US
Telephone Number	:	410-628-0010
Fax Number	:	410-628-4837

Provider Business Practice Location Address
First Line	:	3421 SWEET AIR RD
Second Line	:	SUITE 5
City	:	PHOENIX
State	:	MD
Zip	:	21131-1812
Country	:	US
Telephone Number	:	410-628-0010
Fax Number	:	410-628-4837

Authorized Official
Title or Position	:	CHIROPRACTOR
Name	:	DR. MARIA YIASSEMIDES
Credential	:	D.C.
Telephone Number	:	410-628-0010

Provider Enumeration Date	:	01/20/2012
Last Update Date	:	01/20/2012

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